PAS 251F Pediatrics Exam
what are the unique issues in pediatrics healthcare that are different from adults *** history and
physical changes over time.
dual patient (parent and child are both at the visit and both have input).
early experiences shape brain development and influence lifelong health. weight or age based
medication dosing.
age specific illness and presentation.
vaccine schedules.
anatomic and physiologic differences between children and adults *** immature blood/ blood brain
barrier.
higher respiratory rate.
larger body surface area.
thinner skin.
rapidly dividing cells.
higher metabolic rate.
immature immune system.
key components of pediatric history taking *** *dental history, nutrition, sleep, GI elimination*.
birth history, developmental history, allergies, immunization history, exercise, school history, social
history, family history.
pediatric physical assessment pearls for infants and toddlers *** sit down during the exam (level height
with child).
examine infants and young children in caregiver's lap.
build rapport and establish trust by examining adult first.
let the child play and touch the exam equipment.
,do parts of the exam with them.
start with hear and lung exam while child is quiet.
pediatric physical assessment pearls for pre-school and school age children *** ask the child the history
questions.
assess development by asking them to draw.
tricks for oropharynx (show me your tongue or breathe like a dog).
tricks for respiratory (blow out candles or blow something off your hand)
pediatric physical assessment pearls for adolescents *** confidentiality is key.
always allow one on one time with provider.
use language the child uses and ask questions more than one way.
foster independence is appropriate (prepare transition to adult care).
may take time to establish trust.
always get consent throughout your exam for patient comfort.
how to assess the pulse in pediatrics *** assess for quality of rate, rhythm, volume.
0-2 years old use apical pulse.
2+ years old use radial pulse.
count for a full minute.
compare upper and lower extremities.
palpate femoral pulses (absent or weak is diagnostic of coarctation of aorta).
pulse is increased during fevers, crying, pain, activity (so might need to take again when calm).
normal heart rates per age group *** premie - 120-170.
0-3 months - 110-160.
,3-6 months - 100-150.
6-12 months - 90-130.
1-3 years - 80-125.
3-6 years - 70-115.
6-12+ years - 60-100.
how to assess respiratory rate in pediatrics *** assess rate and pattern.
take when child is quiet.
count for a full minute.
normal breathing for infants is obligate nose breathers, use diaphragm for breathing, and periodic
breathing (pauses during breathing).
normal respiratory ranges per age group *** premie - 40-70.
0-3 months - 30-60.
3-6 months - 30-45.
6-12 months - 25-40.
1-3 years - 20-30.
3-6 years - 20-25.
6-12 years - 14-22.
>12 years - 12-18.
respiratory distress in pediatrics *** increased respiratory rate. retractions or use of accessory muscles.
nasal flaring. head bobbing. grunting. stridor. audible wheeze. change in skin color.
oxygen saturation in pediatrics *** use pulse oximetry. <95% is concerning
, blood pressure assessment in pediatrics *** begin measuring in all children age 3. (can assess if <3yo if
they have chronic, renal, cardiac disease).
use correct size cuff.
crying or anxious children can have higher BP.
normal pressure depends on age and weight.
HTN is >95th percentile at 3 different visits.
stages of hypertension in pediatrics *** normal: <90th percentile.
elevated: >90th percentile to <95th percentile. or 120/80 to <95th percentile.
stage 1 HTN: >95th percentile to <95th percentile + 12mmHg. or 130/80 to 139/89.
stage 2 HTN: >95th percentile + 12mmHg. or >140/90.
normal blood pressure levels per age group *** premie - 55-75/35-45
0-3 months - 65-85/45-55.
3-6 months - 70-90/50-65.
6-12 months - 80-100/55-65.
1-3 years - 90-105/55-70.
3-6 years - 95-110/60-75.
6-12 years - 100-120/60-75.
>12 years - 100-120/70-80.
Assessing for orthostatic hypotension *** take BP and HR after 5min of supine rest.
repeat after 3min of standing.
systolic BP drop >20 or diastolic >10 then should be concerned.
wong-baker faces pain rating scale *** 0 = no hurt.
what are the unique issues in pediatrics healthcare that are different from adults *** history and
physical changes over time.
dual patient (parent and child are both at the visit and both have input).
early experiences shape brain development and influence lifelong health. weight or age based
medication dosing.
age specific illness and presentation.
vaccine schedules.
anatomic and physiologic differences between children and adults *** immature blood/ blood brain
barrier.
higher respiratory rate.
larger body surface area.
thinner skin.
rapidly dividing cells.
higher metabolic rate.
immature immune system.
key components of pediatric history taking *** *dental history, nutrition, sleep, GI elimination*.
birth history, developmental history, allergies, immunization history, exercise, school history, social
history, family history.
pediatric physical assessment pearls for infants and toddlers *** sit down during the exam (level height
with child).
examine infants and young children in caregiver's lap.
build rapport and establish trust by examining adult first.
let the child play and touch the exam equipment.
,do parts of the exam with them.
start with hear and lung exam while child is quiet.
pediatric physical assessment pearls for pre-school and school age children *** ask the child the history
questions.
assess development by asking them to draw.
tricks for oropharynx (show me your tongue or breathe like a dog).
tricks for respiratory (blow out candles or blow something off your hand)
pediatric physical assessment pearls for adolescents *** confidentiality is key.
always allow one on one time with provider.
use language the child uses and ask questions more than one way.
foster independence is appropriate (prepare transition to adult care).
may take time to establish trust.
always get consent throughout your exam for patient comfort.
how to assess the pulse in pediatrics *** assess for quality of rate, rhythm, volume.
0-2 years old use apical pulse.
2+ years old use radial pulse.
count for a full minute.
compare upper and lower extremities.
palpate femoral pulses (absent or weak is diagnostic of coarctation of aorta).
pulse is increased during fevers, crying, pain, activity (so might need to take again when calm).
normal heart rates per age group *** premie - 120-170.
0-3 months - 110-160.
,3-6 months - 100-150.
6-12 months - 90-130.
1-3 years - 80-125.
3-6 years - 70-115.
6-12+ years - 60-100.
how to assess respiratory rate in pediatrics *** assess rate and pattern.
take when child is quiet.
count for a full minute.
normal breathing for infants is obligate nose breathers, use diaphragm for breathing, and periodic
breathing (pauses during breathing).
normal respiratory ranges per age group *** premie - 40-70.
0-3 months - 30-60.
3-6 months - 30-45.
6-12 months - 25-40.
1-3 years - 20-30.
3-6 years - 20-25.
6-12 years - 14-22.
>12 years - 12-18.
respiratory distress in pediatrics *** increased respiratory rate. retractions or use of accessory muscles.
nasal flaring. head bobbing. grunting. stridor. audible wheeze. change in skin color.
oxygen saturation in pediatrics *** use pulse oximetry. <95% is concerning
, blood pressure assessment in pediatrics *** begin measuring in all children age 3. (can assess if <3yo if
they have chronic, renal, cardiac disease).
use correct size cuff.
crying or anxious children can have higher BP.
normal pressure depends on age and weight.
HTN is >95th percentile at 3 different visits.
stages of hypertension in pediatrics *** normal: <90th percentile.
elevated: >90th percentile to <95th percentile. or 120/80 to <95th percentile.
stage 1 HTN: >95th percentile to <95th percentile + 12mmHg. or 130/80 to 139/89.
stage 2 HTN: >95th percentile + 12mmHg. or >140/90.
normal blood pressure levels per age group *** premie - 55-75/35-45
0-3 months - 65-85/45-55.
3-6 months - 70-90/50-65.
6-12 months - 80-100/55-65.
1-3 years - 90-105/55-70.
3-6 years - 95-110/60-75.
6-12 years - 100-120/60-75.
>12 years - 100-120/70-80.
Assessing for orthostatic hypotension *** take BP and HR after 5min of supine rest.
repeat after 3min of standing.
systolic BP drop >20 or diastolic >10 then should be concerned.
wong-baker faces pain rating scale *** 0 = no hurt.
